The single most important thing an RN interested in U.S. employment should do is begin processing his or her Visa Screen. This is a process that takes a minimum of 6 months to complete and is a prerequisite to obtaining a U.S. immigrant visa.

The United States has an acute shortage of nurses that is so severe that the U.S. Department of Labor pre-certified the registered nursing occupation as a shortage occupation several years ago. This pre-certification allows foreign nurses to quickly immigrate to the United States.

Because of pre-certification, employers may petition the United States Citizenship and Immigration Services (_USCIS_, formerly known as the INS) directly for an immigrant visa and bypass the laborious Labor Certification process. This shaves off years of processing for permanent residency status also known as the green card. Essentially, RNs are only required to show that they are qualified for the nursing position.

This qualification is demonstrated through a process called the Visa Screen. The United States requires that immigrating RNs obtain a certificate known as the Visa Screen issued by the Commission on Graduates of Foreign Nursing Schools (CGFNS). The CGFNS conducts an assessment of an applicant�s foreign education to ensure that it is comparable to that of a U.S. graduate in the same profession. It also verifies that the applicants licenses are valid and unencumbered, and determines the applicant�s English language proficiency. Finally it verifies that the nurse has either earned a CGFNS Certificate or passed the National Counsel Licensure Examination for Registered Nurses (NCLEX-RN). Applicants must successfully complete all three parts of the Certification Program in order to earn the CGFNS Visa Screen.

Nurses who successfully pass the CGFNSs nursing knowledge exam are awarded the CGFNS Certificate. This exam is administered at select locations worldwide and is a prerequisite for sitting for some state licensing exams. The NCLEX-RN exam is given only in the U.S. and its territories which include Guam and American Samoa. Since all states require passing the NCLEX exam, it is the preferred exam to take.

The U.S. Consulate in Manila is notorious for being one of the most difficult consulates in the world to obtain a tourist visa to visit the U.S. But, the Consulate will usually grant RNs tourist visas to Guam in order to sit for the NCLEX exam. For those thinking of taking this exam, it is well worth the extra expense to travel to a U.S. territory to take the exam. The NCLEX also makes RNs more marketable because employers can use them right away.

For example, a hospital in California cannot employ RNs who are not licensed in California. A Filipino RN who sits for the NCLEX in Saipan and designates California as the licensing state on the exam, will be in higher demand once the RN passes the exam. The RN will be allowed to be employed as an RN by the hospital immediately.

RNs who pass the CGFNS exam will still have to take the NCLEX at some point in order to obtain state licensing. So, nurses who have a choice should take the NCLEX exam. The NCLEX Board is currently considering offering the exam overseas. But, this will probably not occur for at least a few years. Until then, if a RN has the option of traveling to the U.S or its territories to take the NCLEX exam, the nurse should take this option over sitting for the CGFNS exam.

The CGFNS Visa Screen also requires an assessment of the RNs spoken and written English knowledge. The three English tests currently accepted are the TOEFL, the Test for English in International Communication, and the International English Language Testing System. RNs who have obtained their nursing degrees in the United States, Australia, New Zealand, United Kingdom, and Canada (except for Quebec) are exempted from the English language requirement.

The CGFNS takes several months to issue a Visa Screen once all the exam results are submitted to it. Therefore, it is important for RNs to begin this process as soon as possible. Once a Visa Screen is issued by the CGFNS, it may then be submitted to the U.S. Consulate along with an approved immigrant visa petition. RNs already in the U.S. may use the Visa Screen to adjust their status to that of legal permanent resident with the USCIS.

Armed with a Visa Screen, foreign nurses are able to immigrate to the U.S. much faster than most other occupations being sponsored for legal permanent residency. The USCIS process for obtaining a green card is sufficiently complex that it is best for the layperson to obtain professional representation in the matter. For more information please visit www.rreeves.com

Laughter is one of the most effective ways to manage stress. In fact, there's a science to the stress-reducing impact of laughter. It's called psychoneuroimmunology. What this science says is that laughter can help you boost your immune system functioning. This, in turn, means that you will be less prone to colds and flus and, if you do get sick, you will get better that much faster. If you can't make yourself laugh, then go see someone who makes people laugh for a living—a comic.

Be flexible

Everybody has a unique way of looking at, and interacting with, the world. Some people tend to be a little warm and easy to get to know; others a bit more aloof and distant. As well, some people are dominant or very assertive, and others are meek and perhaps passive. The way you typically see the world and respond to events and people in it is called your personality. A sure-fire way to manage stress is to experiment with different parts of your personality. Be flexible. You don't always have to be passive or controlling. Similarly, sometimes you can try being a bit warmer rather than distant. Do whatever the situation demands, not what your habit or "way" or personality dictates. Being more flexible in your personality helps you manage stress by allowing you to try different ways of talking to people and dealing with events rather than acting out of habit or doing what makes you feel safe. Want to know more about being flexible?

Breathe

We breathe to fill our lungs with oxygen, the fuel for our bodies, and release waste products from inside. When we become stressed, our bodies demand considerably more fuel. Hence, we start to breath more rapidly and our heart rate increases. However, we also breathe more shallowly so there isn't a very efficient and healthy exchange between getting fresh oxygen in and getting waste gases out. Poor breathing contributes in this way to anxiety and fatigue, and makes stressors harder to cope with.

Relaxed breathing is an effective way to manage stress. Be aware of your breathing. Think "my body can relax," inhale slowly and purposefully noticing the breath as it enters through your nostrils and fills your lungs. Expand your abdomen as you breathe to the count of four, hold the breath for a moment, and slowly exhale to the count of four. For your second breath, visualize warmth and relaxation entering your body as you inhale; tension exiting your body as you exhale. This is a good technique to use when you get a stressful phone call, for example. Put the person on hold, take your breath, release it slowly and thoughtfully, then return to the call. You can also take a few deep, relaxing breaths while in a washroom cubicle, waiting at a traffic light, waiting for a meeting to begin, etc.

Note: If you feel faint when taking deep breaths you should sit down, bend over so that your head drops to the height of your knees, and breathe as you normally do. Sit up slowly.

Say "no"

Stress management is sometimes a matter of reducing the demands that are placed upon you. However, many of these demands come from saying "yes" to too many things. Are you a "yay-sayer" (e.g. "sure, I'll do all the cooking for the party", "certainly, I can work overtime anytime you need me to"). Think about the things that you would like to do and separate these from the things that you have to do and begin to say "no" to some of the expectations other people place upon you if they aren't "have to's." A cautionary note, however. Sometimes we have to do things that we don't like despite temporary feelings of discomfort. You are the best judge. Do what takes care of you, your career, your family, and your relationships. Everything else you agree to is a bonus and should only be considered if you have time and energy.

Make mistakes and live with them

Believe it or not, this is good advice. Being perfect at everything you do is very taxing and stressful. You don't have to be the best at everything. Keeping up with Martha Stewart can be draining, and following the steps of the fast-rising executive, demeaning. My own research shows that sometimes people who set high standards for themselves get caught in a perfection trap. If they succeed at meeting their personal standards, they only set their standards higher the next time round. So they never feel that they have done a good job. Be a little less hard on yourself, let yourself make some mistakes if they aren't critical.

Set reasonable goals and strive to do your best. Learn from failure but don't beat yourself over the head when you make a mistake. Be a bit easier on yourself. Can you manage that? Well, try.

Play with a pet

There is a lot of wisdom in this tip. First of all, playing with a pet can distract you from your worries. So rather than ruminate and feel stressed, focus your thoughts on your pet and thereby begin to feel better. Second, there is a real physical benefit to playing with pets. It can leave you feeling happier and healthier. Finally, playing with your pet may offer you a chance to get active. If you have an animal that likes to run outside, go out and throw a ball for it to retrieve (it doesn't work with my pet—a hedgehog). You'll feel refreshed and, consequently, less stressed.

Article contributed by Scott Wallace, Ph.D., R.Psych., For more articles, go to www.virtualpsych.com.